Bariatric emergencies after surgery

The rate of admission in the emergency department during the first year after bariatric surgery is around 6 and 21%. One third of these emergency admissions occur within the first weeks after surgery, whereas others may happen many years after. The surgical complications depend on the type of surgery, and include: occlusions (anastomotic stenosis, internal hernia), hemorrhage (suture, ulcer), septic problem (abscess, fistula, and perforation), parietal complications or complications of the device (banding move or intragastric migration, tube disjunction). Five medical complications are of most concern: pulmonary embolism and cardiac dysfunction the first days after surgery; anemia because of bleeding; dehydration and ionic troubles; micronutrient deficiencies and particularly group B vitamins that should be suspected once neurologic or neuropsychiatric signs are present. Problems associated with the management of obese patient add to the difficulties of interpretation of symptoms, physical examination and radiologic results during emergency admissions. A bariatric emergency should be suspected if tachycardia is above 120 beats/min with sepsis, dyspnea or agitation, if abdominal pain or vomiting occurred and cannot be explained by diet, and required a surgical consulting. If anastomotic link or occlusion on internal hernia is suspected, explorative surgery should be performed urgently, given prognosis (death and intestine necrosis in particular) depends on timely surgery.